OPTICAL NEURITIS AFTER BEE STING: A CASE REPORT

Abstract

A variety of unusual or unexpected reactions have been described occurring in a temporal
relationship to insect stings, although there is scarce information regarding the pathogenesis of the
majority of these unusual reactions Reisman, 2005).Acute encephalopathy occurred 8 days after
yellow jacket stings, without any other obvious cause (Maltzman, Lee, and Miller, 2000). There
have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and
Guillain-Barré syndrome related to insect stings. Schiffman et al. (Schiffman et al., 2004) reported
on a middle aged woman who sustained both a stroke and ischaemic optic neuropathy after
multiple bee stings. As the result of ocular stings, local reactions have occurred with corneal
pathology leading to cataracts (Choi and Cho, 2000)(Keller, 1995). Other prior reported reactions
to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy
(Berríos and Serrano, 1994) (Berríos and Serrano, 1994; Song and Wray, 1991).

Full text

ORIGINAL RESEARCH ARTICLE
OPTICAL NEURITIS AFTER BEE STING: A CASE REPORT
2,3Maurizio Cavallini,1,3,*Marco Ermete Boido,2,3,4Ilaria Lombardi, 2,3Claudia Aceto
and 3,5Tatsiana Volchik
1Department of General Psychology, University of Padova, Italy
2Department of General Psychology, University of Turin, Italy
3Department of Neuroscience, Studio Medico Associato Mind, Asti Italy
4Department of Clinical Psychology and Healt, Cardinal Massaia Hospital, Asti Italy
5Department of Chemestry,University of Minsk
ARTICLE INFO ABSTRACT
A variety of unusual or unexpected reactions have been described occurring in a temporal
relationship to insect stings, although there is scarce information regarding the pathogenesis of the
majority of these unusual reactions Reisman, 2005).Acute encephalopathy occurred 8 days after
yellow jacket stings, without any other obvious cause (Maltzman, Lee, and Miller, 2000). There
have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and
Guillain-Barré syndrome related to insect stings. Schiffman et al. (Schiffman et al., 2004) reported
on a middle aged woman who sustained both a stroke and ischaemic optic neuropathy after
multiple bee stings. As the result of ocular stings, local reactions have occurred with corneal
pathology leading to cataracts (Choi and Cho, 2000)(Keller, 1995). Other prior reported reactions
to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy
(Berríos and Serrano, 1994) (Berríos and Serrano, 1994; Song and Wray, 1991).
Copyright ©2017, Maurizio Cavallini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION
A variety of unusual or unexpected reactions have been
described occurring in a temporal relationship to insect stings,
although there is scarce information regarding the
pathogenesis of the majority of these unusual reactions
(Reisman, 2005). Acute encephalopathy occurred 8 days after
yellow jacket stings, without any other obvious cause
(Maltzman, Lee, and Miller, 2000). There have been prior
reports of other neurological reactions, myasthenia gravis,
peripheral neuritis and Guillain-Barré syndrome related to
insect stings. Schiffman et al. (Schiffman et al., 2004) reported
on a middle aged woman who sustained both a stroke and
ischaemic optic neuropathy after multiple bee stings.
*Corresponding author: Marco Ermete Boido
1Department of General Psychology, University of Padova, Italy
3Department of Neuroscience, Studio Medico Associato Mind, Asti
Italy
As the result of ocular stings, local reactions have occurred
with corneal pathology leading to cataracts (Choi and Cho,
2000) (Keller, 1995). Other prior reported reactions to ocular
stings include conjunctivitis, corneal infiltration, lens
subluxation, and optic neuropathy (Berríos and Serrano, 1994)
(Berríos and Serrano, 1994; Song and Wray, 1991).
Case report
A 66-year-old woman, whose past medical history was
significant only for controlled arterial hypertension and
diabetes mellitus, presented at emergency room after being
stung by an hornet on the left temporal region of the head. She
received an antiseptic medication and then she was discharge.
The day after, the patient experienced a severe headache with
nausea and vomiting and sudden blurred vision in the left eye.
An ocular examination revealed best corrected visual acuity
(BCVA) of 20/20-1 right eye and 20/30-2 left eye at distance
and 20/20 right eye and 20/200 left eye at near. Pupil
examination showed isocoria with no relative afferent
pupillary defect.
ISSN: 2230-9926
International Journal of Development Research
Vol. 07, Issue, 12, pp.17708-17709, December, 2017
Article History:
Received 17th September, 2017
Received in revised form
14th October, 2017
Accepted 09th November, 2017
Published online 29th December, 2017
Available online at http://www.journalijdr.com
Key Words:
Optical Neuritis,
Bee Sting.
Citation: Maurizio Cavallini, Marco Ermete Boido, Ilaria Lombardi, Claudia Aceto and Tatsiana Volchik. 2017.
“Optical neuritis after bee sting: a
case report.”, International Journal of Development Research, 7, (12), 17708-17709.
ORIGINAL RESEARCH ARTICLE OPEN ACCESS

Motility was unremarkable, as was anterior segment both eyes
and the funduscopic examination. Intraocular pressures were
18 mm Hg right eye and 16 mm Hg left eye. A Head
computed tomography was performed and resulted normal.
There was a delay in the P100 wave of the pattern visual
evoked potential (VEP) recording from the left eye, with a
normal response in the right eye. The patient received acute
treatment with high dose intravenous methylprednisolone (1 gr
day for 3 days) followed by 5 days with oral prednisone (1 mg
kg). Three days later, no recovery of the visual acuity in the
left eye was noticed: neuro-ophthalmic examination showed
BCVA of 20/15 right eye and 20/25 left eye at distance and
20/20 right eye and 20/30+1 at near; the pattern VEP was
abnormal. A further ocular examination 4 weeks after her sting
episode showed BCVA of 20/15 right eye and 20/25 left eye at
distance and 20/20 right eye and 20/30+1 at near. Three
months after, the patient reported no improvement of the visual
acuity in her left eye, and the data was confirmed by a repeated
visual examination.
DISCUSSION
The electrophysiological recordings initially showed a delay in
the P100 wave of the pattern visual evoked potential. The data
suggests that the optic nerve was demyelinated acutely, and
that subsequently axonal loss and degeneration of retinal
ganglion cells occurred. On follow-up, no visual acuity
recovery was reported.
Conclusion
It is important that clinicians be aware of this relationship
when assessing people with these reactions. Despite the few
previously report, in our patient an early corticosteroid
treatment was uneffective.
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17709 Maurizio Cavallini et al.
Optical neuritis after bee sting: A case report
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